[Does Provision of Care in Child and Adolescent Psychiatry End when Viruses Come? Hometreatment in Times of Covid-19]

During the Covid-19 pandemic, provision of care in child and adolescent psychiatry was a challenge: Emergency presentations as well as psychiatric problems in children and adolescents increased, while at the same time capacity of inpatient treatment was reduced due to closed inpatient departments and staff shortage. Altogether quarantine, social distancing, testing and hygenic measures complicated daily life as well as inpatient treatment. This article describes the change in numbers of inpatient emergency admissions and prevalent mental health diagnoseses, as well as the role of hometreatment during Covid-19 pandemic. It can be demonstrated that the hometreatment team was able to operate without reduction of treatment capacities throughout the Covid-19 pandemic as long as they took care that basic hygienic measures were in place, Not one single case of Covid-19 infection was transmitted. Hometreatment proved to be an effective treatment alternative for children and adolescents with mental health problems and their families during Covid-19.

Screening for Social Determinants of Health Among Medicare Beneficiaries in Primary Care During the Covid-19 Pandemic in Prince George's County, Maryland

Primary care providers in Prince George's County, Maryland reported inconsistencies in their ability to identify and refer patients with social care needs. This project aimed to improve health outcomes of Medicare beneficiaries by implementing social determinant of health (SDOH) screening to identify unmet needs and improve rates of referral to appropriate services. Buy-in was achieved from providers and frontline staff via stakeholder meetings at a private primary care group practice. The Health Leads questionnaire was modified and integrated into the electronic health record. Medical assistants (MA) were trained to conduct screening and initiate care plan referrals prior to visits with the medical provider. During implementation, 96.25% of patients (n = 231) agreed to screening. Of these, 13.42% (n = 31) screened positive for at least one SDOH need, and 48.39% (n = 15) reported multiple social needs. Top needs included social isolation (26.23%), literacy (16.39%), and financial concerns (14.75%). All patients screening positive for one or more social needs were provided referral resources. Patients who identified as being of Mixed or Other race had significantly higher rates of positive screens (p = 0.032) compared to Caucasians, African Americans, and Asians. Patients were more likely to report SDOH needs during in-person visits (17.22%) compared to telehealth visits (p = 0.020). Screening for SDOH needs is feasible and sustainable and can improve the identification of SDOH needs and resource referrals. A limitation of this project was the lack of follow-up to determine whether patients with positive SDOH screens had been successfully linked to resources after initial referral.

Fear, loss and disconnection: the emotional impact of the Covid-19 pandemic upon staff working in mental health services and how the organization can help - a psychoanalytic perspective

This paper describes the work of a psychoanalyst working within NHS mental health services in the UK . The central contribution of a psychoanalytic approach within psychiatric care in offering a committed attempt towards understanding the patients' presentation, rather than treatment primarily aimed at symptom control, is described. Beyond this, the specific contribution of psychoanalytic ideas in establishing a containing framework for staff, and how this strengthens the capacity of the organisation as a whole to contain anxiety and to metabolize complex projective processes is outlined. Examples are given with clinical illustrations of activities which enhance this capacity in ordinary times.The author then turns to the impact of the covid-19 pandemic upon staff and patients, describing how fear, threat and experiences of multiple losses have permeated all areas of our lives and activated primitive defences. The pandemic starkly revealed profoundly disturbing questions about our assumptions and habits, adding to the intensity and multi-layered quality of the anxieties evoked . Urgent attention has been drawn to our deeply problematic relationship with the natural world, our own habitat, and indefensible social inequities have been crudely exposed. Staff have been caught between their own fear, the need to contain increased disturbance in their patients, already struggling with fragmented and disordered states of mind, and pressures from an organisation under intense strain. The capacity of mental health staff to act as containers for their patient's distress has been profoundly challenged and compromised.This paper outlines how the pandemic has highlighted the crucial role of the organisation as a container for anxiety and in supporting staff to do their work in mental health care. In order to strengthen this capacity during the crisis, the author describes how ideas derived from psychoanalytic principles were developed into guidance for NHS Mental Health Trusts during the early days of the pandemic . This guidance was adopted nationally by the Royal College of Psychiatrists and is summarised in this paper.

Experiences of the Occupational Therapists During the COVID-19 Pandemic: A Scoping Review

Occupational therapy has been impacted by the worldwide COVID-19 pandemic and has transitioned from a traditional face-to-face therapy method to an online one. In the wake of the pandemic, occupational therapist faced the challenge of providing online services to people with disabilities. The review aimed to identify and synthesize the best available evidence on the experience of occupational therapists in psychiatric rehabilitation settings during the COVID-19 pandemic. Additionally, the challenges posed by changes in the mode of training were examined. Electronic database search included PubMed, PsycINFO, PsycNET, Cochrane Library, Ovid, MEDLINE, CINAHL, SAGE Journals, Elsevier Science Direct, Springer, Wiley Online Library, JAMA Psychiatry, and Society E-Journals. Inclusion criteria were studies describing the experience of the occupational therapists during the COVID-19 pandemic in psychiatric rehabilitation settings. A systematic search identified 8 studies included quantitative, qualitative and mixed methodology conducted between 2020 and 2022. The findings from the reviewed articles revealed that the complexities and challenges faced by occupational therapists during the COVID-19 pandemic were professional, personal, and organizational; innovative practices were implemented in the psychiatric settings. The review findings expressed both positive (accepting a new mode of training, time saving) and negative experiences (problems with interaction & internet) perceived by the rehabilitation professionals. Enhancing the training of occupational therapists will help in easing the access and know-how of using telerehabilitation services for patients and coping with COVID-19-like situations in the future.

Impact of COVID-19 pandemic in the care of people living with HIV and cancer at an oncologic center in Mexico

BACKGROUND

People living with HIV(PLWH) and cancer are among the most vulnerable patients and require constant access to medical services. We compared the characteristics of PLWH and cancer in Mexico, before and during the COVID-19 pandemic.

METHODS

Patients admitted 1 year before (pre-pandemic) and 1 year after the start of the pandemic (pandemic) were included. Clinical characteristics, HIV-related variables, and 90-day mortality were compared. Data are described a proportions (N,%) and central tendency measures. A multiple regression model for variables associated with 90-day mortality was performed.

RESULTS

Seventy-nine patients were seen in the pre-pandemic period; 92 during the pandemic. Main diagnoses were Kaposi Sarcoma and lymphoma. CD4⁺ cell count at diagnosis was lower during the pandemic: 81 cells/mm³ vs. 128 cells/mm³, p = .035. CD4+<100 cells/mm³ at first consultation increased from 41% to 58% during the pandemic (p = .041). Only BMI <20 kg/m² was associated to death (aOR 8.27, 95%CI 1.74-39.25) (p = .008). The pandemic period was not associated with a higher 90-day mortality.

CONCLUSIONS

PLWH and cancer presented to care with advanced disease overall. This was more pronounced during the pandemic period. Mortality was associated with AIDS-related variables regardless of study period. This underscores the need for strategies to maintain in-person access to health-care services for PLWH.

Physician scheduling problem in Mobile Cabin Hospitals of China during Covid-19 outbreak

In this paper, we investigate a novel physician scheduling problem in the Mobile Cabin Hospitals (MCH) which are constructed in Wuhan, China during the outbreak of the Covid-19 pandemic. The shortage of physicians and the surge of patients brought great challenges for physicians scheduling in MCH. The purpose of the studied problem is to get an approximately optimal schedule that reaches the minimum workload for physicians on the premise of satisfying the service requirements of patients as much as possible. We propose a novel hybrid algorithm integrating particle swarm optimization (PSO) and variable neighborhood descent (VND) (named as PSO-VND) to find the approximate global optimal solution. A self-adaptive mechanism is developed to choose the updating operators dynamically during the procedures. Based on the special features of the problem, three neighborhood structures are designed and searched in VND to improve the solution. The experimental comparisons show that the proposed PSO-VND has a significant performance increase than the other competitors.

Policy responsiveness and institutions in a federal system: Analyzing variations in state-level data transparency and equity issues during the COVID-19 pandemic

In the absence of a coherent federal response to COVID-19 in the United States, state governments played a significant role with varying policy responses, including in data collection and reporting. However, while accurate data collection and disaggregation is critically important since it is the basis for mitigation policy measures and to combat health disparities, it has received little scholarly attention. To address this gap, this study employs agency theory to focus on state-level determinants of data transparency practices by examining factors affecting variations in state data collection, reporting, and disaggregation of both overall metrics and race/ethnicity data. Using ordered logistic regression analyses, we find that legislatures, rather than governors, are important institutional actors and that a conservative ideology signal and socio-economic factors help predict data reporting and transparency practices. These results suggest that there is a critical need for standardized data collection protocols, the collection of comprehensive race and ethnicity data, and analyses examining data transparency and reductions in information asymmetries as a pandemic response tool-both in the United States and globally.

The effects of Covid-19 on Medical Education

Since the start of January 2019, COVID-19 has caused unparalleled disruption to all aspects of life globally, including the delivery of medical education. Each university and institution have a different approach on how medicine, as a course, is taught and delivered, however, generally there is a consensus that in the earlier years, more emphasis should be given to the acquisition of theoretical and scientific knowledge, including anatomy and physiology. In the later years, medical students are then expected to apply their theoretical knowledge in a practical setting by attending various placements and interacting with patients and other healthcare professionals. The duality of this approach results in doctors who are both competent in their knowledge of the basic sciences whilst being good clinicians with sound practical and inter-personal skills. Covid-19 causes an unprecedented interruption to all students, however with courses such as Medicine, whereby a practical element is crucial, the adaptation to deliver the course effectively is more of a challenge. Clinical rotations were cancelled during the start of the pandemic due to concerns about the students and their families contracting the virus and also for the protection of the vulnerable patients in hospitals. In this manuscript we have explored the adaptations made in order to deliver medical education and evaluate the effectiveness of these methods. We will also be discussing the implications and limitations of these methods.

International trade resilience and the Covid-19 pandemic

The Covid-19 pandemic represents a low-probability, high-impact systemic risk that has severely disrupted international trade, reshaping the patterns of globalization. Drawing from the concept of supply chain resilience, which involves both the ability of a system to withstand an impact (robustness) and recover from it (responsiveness), we investigate country-level trade resilience during the 1st wave of the pandemic. By employing Fuzzy-set Qualitative Comparative Analysis (fsQCA), we identify configurations of country-level factors, i.e., country profiles, based on their effectiveness in engendering trade resilience. These factors include social and economic globalization, logistics performance, healthcare preparedness, national government response, and income level. The results show how these factors coalesced to strengthen (or weaken) international trade resilience, contributing to a holistic understanding of the impact of the pandemic on international trade. The findings inform the post-Covid-19 debate on international trade, with implications for managers and policymakers.

[Adaptation of Health Care Organization in a level III Maternity Hospital during the COVID-19 pandemic]

La pandémie COVID-19 a nécessité une adaptation rapide de l’organisation des soins. L’objectif était d’assurer l’accueil des patients en évitant les contaminations au moment de l’accouchement et pour le personnel soignant. Était aussi prise en compte l’instauration des liens parents–enfant essentiels au-delà de la pandémie. La réorganisation des soins a d’abord reposé sur la création d’une équipe opérationnelle multidisciplinaire qui a permis une réactivité indispensable. Ensuite, les activités ont été recentrées sur la situation épidémique avec déprogrammation des activités non urgentes et articulation avec le réseau de ville. Une réorganisation des plannings et une formation spécifique à l’habillage ont été réalisées. Une dotation en masques chirurgicaux, gels et lingettes désinfectants a été assurée. Un triage des admissions a été mis en place avec un circuit particulier et des personnels dédiés. Une salle de naissance et un bloc opératoire spécifiques armés du strict nécessaire ont été associés à un poste de réanimation néonatale particulier. En néonatologie, deux secteurs dont la pression positive a été suspendue étaient dédiés aux familles à risque. Le port du masque et le lavage des mains avec désinfection au gel hydroalcoolique a été exigé de tous les patients. Les enfants ont été laissés au chevet de leurs mères en chambre particulière. Une incitation à l’allaitement maternel a été faite. La sortie précoce dès 48 h a été systématiquement organisée avec relais par sage-femme à domicile. Au total, cette adaptation de l’organisation des soins a permis de répondre de façon satisfaisante à la situation particulière de cette pandémie.

Developing student connectedness under remote learning using digital resources: A systematic review

Online learning is negatively associated with student connectedness. Due to the COVID-19 pandemic, Higher Education (HE) institutions have pivoted to blended and online learning. Subsequently, HE institutions have seen a shift in student connectedness resulting in loneliness, isolation, social and psychological distance. Consequently, it is essential for teacher practitioners to respond with innovative digital learning resources that aim to develop student connectedness. The current systematic review aimed to explore the research question: what are the characteristics of effective digital teaching resources when the aim of the resource is to build student connectedness? This systematic literature review was conducted in line with published guidance for undertaking reviews (Centre for Reviews and Dissemination, 2009). Successively, 17 papers met the inclusion criteria and were analysed using a thematic synthesis approach. Results identified five key themes that are important when designing digital resources to build connectedness: usability; teacher interaction; immediacy; synchronicity; and community. The findings of this research are expected to provide a template to assist teacher practitioners in creating innovative digital resources that facilitate connectedness.

Effects of self-isolation and quarantine on loot box spending and excessive gaming-results of a natural experiment

COVID-19 has prompted widespread self-isolation and citywide/countrywide lockdowns. The World Health Organisation (WHO) has encouraged increased digital social activities such as video game play to counteract social isolation during the pandemic. However, there is active debate about the potential for video game overuse, and some video games contain randomised purchases (loot boxes) that may psychologically approximate gambling. In this pre-registered study, we examined the effects of self-isolation and quarantine on excessive gaming and loot box spending. We recruited 1,144 (619 male, 499 female, 26 other) Australian, Aotearoa New Zealand, and US residents who self reported being quarantined or self-isolating (n = 447) or not (n = 619) during the COVID-19 pandemic to a cross-sectional natural experiment. We compared the associations between problem gambling symptomology, excessive gaming and loot box spending for isolated and non-isolated participants. Participants completed the Kessler-10 Psychological Distress Scale, Problem Gambling Severity Index, Internet Gaming Disorder Checklist, a measure of risky engagement with loot boxes, concern about contamination, and reported money spent on loot boxes in the past month, as well as whether they were quarantined or under self-isolation during the pandemic. Although, in our data, excessive gaming and loot box spending were not higher for isolated (self-isolated/ quarantined) compared to non-isolated gamers, the established association between problem gambling symptomology and loot box spending was stronger among isolated gamers than those not isolated. Concerns about being contaminated by germs was also significantly associated with greater excessive gaming and, to a lesser extent, loot box spending irrespective of isolation status. Gamers might be managing concerns about the pandemic with greater video game use, and more problem gamblers may be purchasing loot boxes during the pandemic. It is unclear whether these relationships may represent temporary coping mechanisms which abate when COVID-19 ends. Re-examination as the pandemic subsides may be required. More generally, the results suggest that social isolation during the pandemic may inflate the effect size of some media psychology and gaming effects. We urge caution not to generalise psychological findings from research conducted during the COVID-19 pandemic to be necessarily representative of the magnitude of relationships when not in a pandemic.

Experiences of American Older Adults with Pre-existing Depression During the Beginnings of the COVID-19 Pandemic: A Multicity, Mixed-Methods Study

OBJECTIVE

To determine the effect of the COVID-19 pandemic on the mental health of older adults with pre-existing major depressive disorder (MDD).

PARTICIPANTS

Participants were 73 community-living older adults with pre-existing MDD (mean age 69 [SD 6]) in Los Angeles, New York, Pittsburgh, and St Louis.

DESIGN AND MEASUREMENTS

During the first 2 months of the pandemic, the authors interviewed participants with a semistructured qualitative interview evaluating access to care, mental health, quality of life, and coping. The authors also assessed depression, anxiety, and suicidality with validated scales and compared scores before and during the pandemic.

RESULTS

Five themes from the interviews highlight the experience of older adults with MDD: 1) They are more concerned about the risk of contracting the virus than the risks of isolation. 2) They exhibit resilience to the stress and isolation of physical distancing. 3) Most are not isolated socially, with virtual contact with friends and family. 4) Their quality of life is lower, and they worry their mental health will suffer with continued physical distancing. 5) They are outraged by an inadequate governmental response to the pandemic. Depression, anxiety, and suicidal ideation symptom scores did not differ from scores before the pandemic.

CONCLUSION

Most older adults with pre-existing MDD show resilience in the first 2 months of the COVID-19 pandemic but have concerns about the future. Policies and interventions to provide access to medical services and opportunities for social interaction are needed to help to maintain mental health and quality of life as the pandemic continues.